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As a development agency, UNDP focuses on addressing the social, economic and environmental determinants of health, recognizing that health is both a driver and outcome of development. In line with its primary mission to support country-led efforts to achieve the 2030 Agenda for Sustainable Development, in partnership with other stakeholders, UNDP’s work on health and development forms part of holistic efforts to accelerate progress towards the Sustainable Development Goals (SDGs). This includes helping governments to implement large-scale health programmes in challenging and high-risk country contexts and promoting enabling environments for equitable health service delivery through capacity-building and policy engagement.
UNDP’s health and development engagement makes a powerful contribution to countries’ commitment to “leave no one behind” in the achievement of the SDGs. Its activities to strengthen systems for health are guided by an emphasis on supporting governments to attain universal health coverage (UHC), an important target under SDG 3 (healthy lives for all) to advance equitable health outcomes. UHC calls on countries to ensure that people obtain the necessary health services—preventive, curative and rehabilitative—without financial hardship. UNDP embraces a human-rights based approach and looks through a gender equity lens to address the underlying drivers of health inequalities, including law, rights and policy barriers, to ensure that all populations have equal access to safe and affordable medicines, vaccines, and other basic health services.
In close collaboration with government, civil society organizations and partners, including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), WHO and other UN agencies, UNDP helps to strengthen the resilience, sustainability, and inclusiveness of systems for health in low-and middle-income countries. As outlined in the UNDP HIV, Health and Development Strategy 2016-2021: Connecting the Dots, this work falls under three interconnected areas of action:
- reducing inequalities and social exclusion that drive HIV and poor health
- promoting effective and inclusive governance for health
- building resilient and sustainable systems for health
In 2018, UNDP provided support to systems for health in over 60 countries, totalling US$1.3 billion in signed agreements. A significant part of this work relates to UNDP management of Global Fund grants for large-scale HIV, TB, and malaria programmes in 18 countries, and three regional programmes that cover 29 countries. In another 20 countries, UNDP provides direct support to national partners for health implementation and systems strengthening, such as capacity-building to strengthen national institutions or support for health procurement.
These efforts form part of UNDP’s overarching vision to help countries achieve sustainable development by eradicating poverty in all its forms and dimensions, accelerating structural transformations for sustainable development and building resilience to crises and shocks, as outlined in the UNDP Strategic Plan 2018-2021.
As part of promoting effective governance, technical support to enhance transparency and accountability within the health sector, in partnership with the Global Fund, WHO, and others, is an important component of UNDP’s health systems strengthening activity. All health interventions are underpinned by efforts to ensure sustainability, including a focus on environmental sustainability. UNDP’s work on planetary health brings together efforts on climate action (SDG 13) with health programming to offer win-win solutions for the health of people and the planet. For example, UNDP supports innovative initiatives that embed sustainability into health procurement practices and promotes the use of clean energy to reduce the carbon footprint of health facilities.
While the SDGs provide an invaluable framework for multisectoral action on health, there are as yet no comprehensive, widely applicable systems or methodologies for integrated approaches to interconnected development challenges. UNDP’s role as an integrator and connector, as illustrated by its ability to bring together governments with citizens, the private sector, civil society, and other partners at the global and country level, helps to strengthen the means of implementation (SDG 17) for health and development interventions.
The following tenets guide UNDP’s approach and priorities for health and development support:
Health is central to the Sustainable Development Goals
As articulated by the UNDP Administrator, Achim Steiner, “health plays a central role in achieving the Sustainable Development Goals and is both a precondition and an outcome of sustainable development”.
Good health and well-being, as preconditions for and critical outcomes of sustainable development, are central to the 2030 Agenda. The “five Ps” that characterize the expansive SDG agenda—people, planet, prosperity, peace, and partnership—underscore the importance of multisectoral efforts and the close connections between the SDGs and the role for health.
The SDG 3 target for UHC, which includes financial risk protection and access to quality essential health-care services for all, clearly demonstrates the interrelationship between the social, economic, and environmental determinants of health. Ensuring that poor, vulnerable, and marginalized groups have access to health services requires concerted investments in strengthening governance and addressing the corruption that contributes to weak and inefficient systems for health. It equally depends on addressing the multiple interconnected forms of inequality and the related risks that hinder key populations from accessing available services, such as discrimination, stigma, and legal barriers.
Environmental risk is also a major contributor of health inequalities: WHO estimates that 23 percent of all deaths could be attributed to environmental issues such as air pollution, poor sanitation, exposure to radiation and other environment-related causes. The convergence of health and environment challenges underline the need to combat climate change and environmental degradation (SDG 13) to safeguard health outcomes. The diverse drivers of inequity that undermine the achievement of UHC, in turn, threaten progress on SDG 1 (eliminate poverty) through a number of economic pathways. WHO indicates, for example, that catastrophic health spending has pushed almost 100 million people into poverty annually while leaving over half of the world’s population without access to essential health services”. i
The 2030 Agenda is an opportunity to address health, human rights, humanitarian and other development challenges in a more integrated and comprehensive manner than ever before. UNDP’s mandate to support governments to achieve the SDGs and its role as a convener place it in a unique position to promote synergies across sectors and ensure that health is addressed as part of a broader sustainable development response. Its support to build resilient and sustainable systems for health contributes to numerous SDG targets, in particular:
- by 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases (SDG3)
- by 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status (SDG3)
- develop effective, accountable and transparent institutions at all levels (SDG3)
- enhance the global partnership for sustainable development, complemented by multi-stakeholder partnerships that mobilize and share knowledge, expertise, technology and financial resources, to support the achievement of the sustainable development goals (SDG3)
Health is a priority in fragile contexts
Conflicts, protracted crises and health shocks increase fragility and exacerbate the vulnerability of people in countries that lack resilient systems for health.
As a result of the lengthy conflict in Syria, for example, nearly 60% of public hospitals in the country were either only partially functional or had been completely destroyed by late 2015, highlighting the crucial need for integrating health policies and programming with broader humanitarian responses and recovery efforts.
People displaced during shocks and crises are particularly vulnerable due to lack of adequate access to health care and social protection; one of every 22 people living with HIV, for example, was affected by a humanitarian emergency in 2013. The Ebola outbreak in West Africa in 2014-15 demonstrated how a major health crisis could produce a severe economic impact due to lost livelihoods and declines in household incomes and GDP. The outbreak also highlighted the importance of strengthening core government functions, such as the ability to pay health workers, in order to build more resilient systems for health.
Countries in crisis or post-crisis contexts face significant capacity constraints. Resilient systems for health are needed more than ever where political turmoil persists and where natural disasters are most prone to strike. A targeted approach ensures the most vulnerable are reached. UNDP continues to work with governments to help focus on geographic areas of most need, or where epidemics present a public health concern. More investments in strengthening health and community systems can ensure that those most in need receive vital assistance.
UNDP works in close partnership with other UN agencies, drawing on the comparative advantages of each to deliver integrated support to countries facing health emergencies. In a UNDP-WHO Memorandum of Understanding signed in May 2018, joint action on health emergencies is identified as one of three key focus areas for the partnership. The collaboration aims to support multisectoral responses to health emergencies, ensuring delivery of essential health services in fragile, vulnerable and conflict-affected settings.
Make zero discrimination a reality now
UNDP’s health programming and policy support is underpinned by the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
The right to health, including through UHC, cannot be exercised when discrimination based on disease status, socioeconomic circumstances, or identity persists. UNDP is committed to reducing inequality and promoting inclusion and is working with partners to tackle stigma and discrimination and remove punitive laws to enable universal access to health and social services. This inclusive approach to health interventions is consistent with UNDP’s broader SDG implementation support and joint framework help countries assess the interlinked factors that result in people being left behind: discrimination; geography; socioeconomic status; poor governance; and vulnerability to shocks.
As a co-sponsor of the Joint UN Programme on HIV/AIDS (UNAIDS) UNDP supports the implementation of the UNAIDS 2016–2021 Strategy to end the AIDS epidemic as a public health threat by 2030. The strategy’s focus on the critical links between HIV, health, human rights, inequality, poverty and conflict are of particular importance to UNDP. Within the UNAIDS division of labour, updated in 2018, UNDP is the convening agency for the “human rights, stigma and discrimination” focus area, while it co-convenes on “HIV prevention among key populations” with UNFPA, and on “investment and efficiency” with the World Bank. In the role of convener and co-convener, UNDP provides technical leadership and supports coordination and knowledge generation to advance strategic action in each respective area.
The Global Fund to fight AIDS, TB, and malaria (Global Fund) is an innovative public-private partnership that has played a crucial role in the world's efforts to respond successfully to these, three of the world’s most damaging diseases. Since its founding in 2002, the Global Fund has raised over US$38 billion to co-finance large-scale prevention, treatment and care programmes in over 150 countries. UNDP’s partnership with the Global Fund is a powerful contributor to health-related development goals, through the key role the partnership plays in supporting countries facing challenging circumstances to strengthen their institutions and systems for health and enable access to essential health services.